NEONATAL MORBIDITY AND MORTALITY ASSOCIATED WITH TRIPLET PREGNANCY

Objective: To compare neonatal morbidity and mortality in a large cohe re of triplet pregnancies with singleton and twin neonates managed at a single tertiary center over a short time. Methods: Records from all triplet pregnancies managed and delivered from 1992 to 1996 were revie wed for neonatal outcome data. Pregnancies delivered before 20 weeks' gestation and neonates with lethal congenital anomalies were excluded. The comparison group comprised all singleton and twin neonates manage d in the same neonatal intensive care unit (NICU) during the same peri od. Results: During the 5-year period, 55 triplet pregnancies and thei r resulting 165 neonates were managed and delivered at this center. Th eir outcomes were compared with those of 959 singleton and 357 twin ne onates born at similar gestational ages. The median gestational age at delivery for triplets was 32.1 weeks, and 149 of the 165 infants were admitted. Sixteen triplet neonates were not admitted to our neonatal intensive care unit, 12 because of previable gestational age, three be cause of stillbirth, and one because of a lethal congenital anomaly. T he crude perinatal mortality rate in triplets was 121 per 1000 births, and there was no significant difference in outcome based on triplet b irth order. There were no significant differences in survival rates be tween singleton, twin, and triplet neonates, with an overall neonatal survival of 95%, 95%, and 97%, respectively. The only significant diff erences in morbidity were an increased incidence of mild intraventricu lar hemorrhage (relative risk [RR] 6.20; 95% confidence interval [CI] 2.64, 14.61), mild retinopathy of prematurity (RR 20.05; 95% CI 3.59, 111.79), and severe retinopathy of prematurity (RR 46.69; 95% CI 6.25, 348.85) in triplets compared with singletons, and severe retinopathy of prematurity (RR 6.83; 95% CI 1.24, 37.56) in triplets compared with twins. Conclusion: When stratified by gestational age, triplet neonat es delivered at 24-34 weeks' gestation have similar outcomes as single ton and twin neonates, with the only clinically significant difference being an increased incidence of retinopathy of prematurity in triplet s. (C) 1998 by The American College of Obstetricians and Gynecologists .